Provider Demographics
NPI:1356943609
Name:NEW LIFE MED CENTER LLC
Entity type:Organization
Organization Name:NEW LIFE MED CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:YUSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COUCEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:305-640-8393
Mailing Address - Street 1:5801 NW 151ST ST STE 106
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2437
Mailing Address - Country:US
Mailing Address - Phone:305-951-8639
Mailing Address - Fax:
Practice Address - Street 1:5801 NW 151ST ST STE 106
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2437
Practice Address - Country:US
Practice Address - Phone:305-640-8393
Practice Address - Fax:305-639-8314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty